How much revenue do you lose annually on patient no-shows? While there might not be one best solution for every practice, here’s a look at the various ways you can approach this problem.
Implement a robust recall system
This is probably the most obvious of the seven, but worth mentioning. With a multitude of options for people to communicate these days, consider a multi-channel approach (email, text, postcard, phone call). You may want to experiment with what channels work best for you, along with frequency and timing of recall. Much of this is dependent on your patient demographic and communication preferences. As a general rule, allow enough time for the patient to adjust plans if needed or reschedule. If you pre-appoint, consider those slots “reservations” until the patient confirms. In a polite manner, let the patient know that if they don’t confirm within a certain time, their reservation will be reopened.
Most practices with high patient demand will book to capacity. Some practices book beyond capacity, anticipating not everyone will show up. Clearly this option has drawbacks, but for some practices that experience exceptionally high no-show rates, it deserves consideration. This is the airline philosophy of overbooking and crossing your fingers that somebody doesn’t show up. Restaurants do this as well. It’s a strategy to avoid losing money, but it’s a pain in the neck for customers who are inconvenienced by this. Before doing this, give strong consideration to the impact it will have on both your staff AND patients when everyone does show up. For many practices, this option flies in the face of great customer service.
See more patients
As an alternative to overbooking, you could adjust your patient schedule to accommodate more people. Let’s say you currently schedule a comprehensive exam every 30 minutes. A no-show will have a more significant impact on revenues than if you scheduled every 20 minutes. Seeing more patients allows you to more easily absorb the occasional no-show. Of course, this also requires you to implement lean and efficient systems, so the increased patient load does not come at the expense of great clinical care or the patient experience.
Charge a no-show fee
Some practices have found success by charging a no-show fee. In most cases, this tends to be a nominal fee that serves as more of a deterrent than a money maker. Some practices even collect the person’s credit card information when the appointment is made, letting them know at that time that a fee will be charged if the patient does not notify the practice within a certain time frame.
I have mixed feelings on this one. If you do this, my advice would be to use it as a deterrent and be very flexible with waiving it. Often times, people have valid or unavoidable reasons for missing an appointment and cancelling at the last minute. My concern is that enforcing this fee will leave a bad first impression with new patients and will alienate established patients who have spent hundreds or possibly thousands of dollars at your practice.
Track chronic offenders
If someone no-shows once, it’s an unfortunate incident. If someone no-shows twice, it’s a pattern. My willingness to be more rigid with enforcing policies increases with chronic offenders. Using your discretion, these are patients you may need to enforce a no-show fee or even inform they can no longer schedule an appointment, but you are happy to accept them on a walk-in basis if there is an opening. Approach this with sensitivity and kindness. Even chronic offenders may have valid reasons, but in the end, you have a business to run.
Change the verbiage
While it’s frustrating when patients no-show, I suspect that most no-shows can be attributed to ignorance rather than malice. This is why it’s important to explain to patients how important it is to call if they must cancel. Things come up. That’s understandable. The biggest problem for the practice is not the no-show itself; the problem is failure to notify the practice and give them an opportunity to schedule someone else in that slot.
A small but effective twist in the verbiage that has worked in the restaurant industry is changing the wording from “call us if you can’t make it” to “will you call us if you change your plans?”, and then wait for their answer. The first approach only required the caller to listen, the second approach required the caller to commit. For one well-known restaurant in Chicago, this simple change reduced no-shows from 30% to 10% and saved the business $900,000 a year in lost revenues.
Explain the “Why”
While most optometrists want their patients to return annually for a comprehensive exam, the patient doesn’t always recognize the need or urgency to return merely because it’s been twelve months. Many patients return when they need us. “I’m on my last pair of contacts doc!”
Twelve months is a standard we apply to most patients, but many patients have conditions that put a higher importance on compliance with regular exams. This isn’t just diabetics and glaucoma suspects. It’s also our dry eye patients, allergy sufferers, early cataract patients, those with a family history of eye disease, and on and on. For these patients, make sure to give the reason for the request. Instead of “we’ll get you scheduled for your next appointment” or “we’ll send you a card next year,” say “I would like you to come back in one year because…” Give the patient a strong and compelling reason to return.
Dr. Vargo serves as Optometric Practice Management Consultant for IDOC. A published author and speaker with more than 15 years clinical experience, he is now a full-time consultant advising ODs in all areas of practice management and optometric office operations. For questions or comments about this article, please contact firstname.lastname@example.org.